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Wk 2, Case 5 - Review

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Patient History
66-year-old male with a history of chest pain with activity. The patient has a history of hypertension, mixed hyperlipidemia, and diabetes mellitus type 2.
Report
Cardiac CT Angiography (Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing
(including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed).) (CPT code: 75574)
TECHNIQUE: Coronary CT Angiography
Prospective ECG gating Cardiac; data acquisition between 65-80 % of the R-R interval Cardiac CT: MDCT CT scanner with a 0.25 s rotation time
IVCM: 85 mL Administered @ 6 mL/s
Medication: Sublingual nitroglycerin 0.8 mg, 200mg oral metoprolol
Heart rate: 60 bpm
Height: 66 in, 138 lbs.
Rhythm: sinus rhythm
Artifacts: none.
Findings:
Coronary CTA:
The quality of the exam is good.
The left and right coronaries arise from their respective normal anatomic ostia. The coronary circulation is right dominant.
LEFT MAIN:
The left main coronary artery is a short vessel that gives rise to the LAD, and LCx arteries. There is no plaque or stenosis in the left main.
LEFT ANTERIOR DESCENDING (LAD):
The LAD is a large vessel that wraps around the apex and gives rise to two diagonal branches. There is a small amount of non-calcified plaque with minimal (1-24%) stenosis of the proximal LAD. There is no plaque or stenosis in the remainder of the LAD or its branches.
LEFT CIRCUMFLEX (LCX):
The left circumflex is a large vessel that gives rise to two obtuse marginal branches before terminating as a diminutive vessel in the AV groove. There is a small amount of non-calcified plaque with minimal (1-24%) stenosis in the first OM branch, with no plaque or stenosis in the distal LCX or the other OM branch.
RIGHT CORONARY ARTERY (RCA):
The RCA is a medium size dominant vessel that gives rise to the PDA and PLV branches. There is a small amount of non-calcified plaque with positive remodeling with minimal (1-24%) stenosis of the proximal RCA and mild (25-49%) stenosis of the mid-RCA. There is no plaque or stenosis in the remainder of the RCA or its branches.
NON-CORONARY CARDIAC FINDINGS:
Chambers: Chamber sizes are normal. No filling defects were seen.
Myocardium: Normal thickness. No outpouching or masses.
Valves: Normal mitral valve thickening. Trileaflet aortic valve with no thickening. Pericardium: No pericardial effusion, calcification, or thickening.
Aorta: There is no aortic rupture, aneurysm, dissection, or intramural hematoma. Pulmonary arteries: No enlargement. No central pulmonary embolism.
Pulmonary veins: Normal venous drainage of all pulmonary veins into the left atrium. No pulmonary vein stenosis.
Impressions
1. Overall, there is a small amount of non-calcified plaque in a multi-vessel distribution.
2. Non-obstructive coronary artery disease with mild (25-49%) stenosis of the mid-RCA and minimal (1-24%) stenosis of the proximal LAD, OM1, and proximal RCA.
3. Unremarkable non-coronary findings.
Recommendations:
CAD-RADS 2 - Mild non-obstructive CAD; Consider non-atherosclerotic causes of chest pain. Consider preventive therapy and risk factor modification, particularly for patients with a non obstructive plaque in multiple segments.
Plaque: P2 moderate amount of plaque.
Final diagnosis: I25.10 CAD, native

Case Discussion

Faculty

Giovanni E. Lorenz, DO

Cardiothoracic Radiologist

San Antonio Military Health System (SAMHS)

Emilio Fentanes, MD

Director of Cardiac Imaging, Department of Cardiology

Brooke Army Medical Center

Tags

Vascular

Coronary arteries

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac CT

Cardiac

Acquired/Developmental

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